For Physicians

Epidemic Keratoconjunctivitis (EKC)

Epidemic keratoconjunctivitis (EKC) is a common and highly contagious acute infection of the eye caused by adenovirus. Typically symptoms manifest as pain, blurred vision, sensitivity to light, edema of the eye lid, and pseudomembrane (1). Complications and permanent damage may occur. There is no universally effective cure, vaccine, or treatment available; topical corticosteroids may provide relief (7). Topical antiviral therapy and povidone iodine eye lavage has shown potential benefit in decreasing the duration of symptoms. Research has reported that corticosteroid treatment may delay the shedding of the cells from the ocular surface by enhancing the adenovirus duplication, not allowing the adenovirus to expire on its own (7). EKC is extremely contagious and often results in cases of epidemics or “runs” in eye care clinics. There is available laboratory testing, as well as rapid in-office testing to identify EKC. Correctly testing and identify EKC is extremely crucial in order to prevent further breakouts. For the majority of nosocomial EKC cases, individuals often contract the virus through routine eye care examinations, by use of contaminated equipment such as tonometers (7,8). With an average incubation period lasting from 7-14 days, affected individuals often do not make the association of contracting the virus with their recent eye examination (6, 7). The virus is known to last on surfaces, such a slit lamps, for an average of 4-6 weeks (7,8,10,11). There is greater severity for the prognosis of EKC than previously thought. Research reveals lasting damage caused by EKC such as permanent corneal damage and the acute symptoms spanning the duration of years. The underplayed original prognosis of EKC requires an updated review and even a possible new approach to handling the virus.

Universal Precautions in Ophthalmology and Optometry Practices- New Guidelines for Improved SafeSight

Standard Precautions are required in the care of all patients at all times:

All staff and providers must wash their hands before and after each patient encounter.

Use disposable gloves for every patient

Equipment and Instruments

Use disposable examination materials when possible

Use disposable tonometer tips on red eye examinations

Use non contact tonometer or disposable tips on all eye examinations

Do not use contact tonometry unless apparatus has been dismantled from slit lamp, scrubbed and soaked in proper disinfectant, rinsed, and fully sterilized

Disposable single use eye drops if available

If only multi-use eye drop vials are available, withdraw individual drops for each patient into a sterile small syringe for each patient use.

Do not directly apply drops from a multi use bottle into any patient’s eye

Eye drop vial must not have contact with the patient

If the bottle does come in contact with the patient’s eye the bottle must be discarded immediately

Typical 70% isopropyl alcohol is NOT an effective sanitizer. Use medical grade disinfectants such as Cavi-Wipes or Sani-Wipes

Dispose of swabs and tissues used in the instillation of eye drops immediately

Patient Examination Area

Separate sign-in and waiting area for potential infected patients and clean all objects that a patient comes in contact with

Designate a specific “pink” room for patients with any eye infections.

Clean and disinfect surfaces after the patient is discharged with medical grade disinfectants.

In Case of an Epidemic Keratoconjunctivitis and Other Infectious Patients

Temporarily remove possibly infected staff member

All EKC diagnosis should be reported to county health departments and state public health offices

Any patient who has been exposed to EKC should be immediately notified and treatment should be discussed with an eye care provider

EKC Prevention and Guideline in Ophthalmic Care Settings

Standard Precautions

All staff members must wash hands before and after each patient encounters

Use disposable gloves for every patient

Any single use item, such as eye drop vials, should be disposed of when possible

Patient Examination Area

Separate sign-in and waiting are for possibly infected patients

Designate specific examination rooms for patients with eye infections

Clean surfaces after the patients are discharged with medical grade disinfectant